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Lavi E, Cohen A, Libdeh AA, Tsabari R, Zangen D, Dor T. Growth hormone therapy for children with Duchenne muscular dystrophy and glucocorticoid induced short stature. Growth Horm IGF Res 2023; 72-73:101558. [PMID: 37683457 DOI: 10.1016/j.ghir.2023.101558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Revised: 08/02/2023] [Accepted: 08/29/2023] [Indexed: 09/10/2023]
Abstract
OBJECTIVE To evaluate the outcome of recombinant human Growth Hormone (rhGH) therapy in patients with Duchene Muscular Dystrophy (DMD) and glucocorticoid treatment with compromised growth. DESIGN Four DMD patients on Deflzacort 0.6-0.85 mg/kg/day or prednisolone 0.625 mg/kg/day recieved rhGH (0.24 mg/kg/week) for 6-18 months. Primary outcomes were Growth velocity and Height for age Z-scores (Height SD). RESULTS Growth velocity increased from 0 to 3.25 cm/year prior to GH therapy to 3.3-7.8 cm/year over a period of 6-18 months. The typical Height SD decline in DMD was reversed in two patients and blunted in one. No adverse events or deterioration in cardiac or respiratory parameters were associated with the rhGH treatment. CONCLUSIONS rhGH appears to be safe and efficient in promoting growth of patients with glucocorticoid induced growth failure in DMD.
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Affiliation(s)
- Eran Lavi
- Division of Pediatric Endocrinology, Hadassah Hebrew University Medical Center, Mount scopus, Faculty of Medicine, Hebrew University of Jerusalem, Israel.
| | - Amitay Cohen
- Division of Pediatric Endocrinology, Hadassah Hebrew University Medical Center, Mount scopus, Faculty of Medicine, Hebrew University of Jerusalem, Israel
| | - Abdulsalam Abu Libdeh
- Division of Pediatric Endocrinology, Hadassah Hebrew University Medical Center, Mount scopus, Faculty of Medicine, Hebrew University of Jerusalem, Israel; Department of pediatrics, Makassed Hospital and Al-Quds University, East Jerusalem, Palestine
| | - Reuven Tsabari
- The pediatric Pulmonology unit Hadassah-Hebrew University medical center, Mount scopus, Faculty of Medicine, Hebrew University of Jerusalem, Israel
| | - David Zangen
- Division of Pediatric Endocrinology, Hadassah Hebrew University Medical Center, Mount scopus, Faculty of Medicine, Hebrew University of Jerusalem, Israel
| | - Talya Dor
- The pediatric neurology unit, Hadassah-Hebrew University Medical Center, Ein-Kerem, Faculty of Medicine, Hebrew University of Jerusalem, Israel
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2
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Gileles-Hillel A, Soesman LH, Miari S, Breuer O, Tsabari R, Elyashar-Earon H, Armoni S, Sprikkelman AB, Reiter J, Zangen D, Lavi E, Kerem E, Cohen-Cymberknoh M. The utility of glucose area under the curve from the oral glucose tolerance test as a screening tool for cystic fibrosis-related diabetes. Pediatr Pulmonol 2022; 57:2774-2780. [PMID: 35999051 DOI: 10.1002/ppul.26100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 06/16/2022] [Accepted: 07/09/2022] [Indexed: 11/12/2022]
Abstract
BACKGROUND Consistently abnormal glucose levels on oral glucose tolerance test (OGTT) are the most effective screening tool for cystic fibrosis-related diabetes (CFRD). However, some cystic fibrosis (CF) patients demonstrate abnormal glucose profiles not reaching levels required for CFRD diagnosis and are, therefore, left untreated. Since CFRD is associated with disease deterioration, early diagnosis and treatment are desirable. AIM To explore the association between the area under the curve of glucose (G-AUC) obtained during a five-point 2-h standard OGTT and CF disease severity parameters. METHODS All CF patients referred for an annual routine OGTT at the Hadassah CF Center between 2002 and 2018, were included. Disease severity parameters were correlated with the G-AUC. RESULTS Two hundred forty-two OGTTs were performed in 81 patients (mean age 19.7 ± 9.0 years); 54% were normal, 14% showed impaired glucose tolerance (IGT), 5% had values in the indeterminate range (INDET), 11% had both IGT and INDET and 16% were diagnosed with CFRD. A gradual increase in mean G-AUC was observed among the groups. In multivariate regression models, G-AUC ≥ 295 mg h/dl was independently associated with an increased number of pulmonary exacerbations (PEx). Not all the patients having this value met the CFRD definition. CONCLUSION Patients who do not fulfill the criteria for CFRD may have abnormal glucose metabolism identifiable by abnormally high G-AUC values, which may be associated with more PEx. The potential advantage of treating these patients with insulin and the subsequent reduction in PEx needs further investigation.
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Affiliation(s)
- Alex Gileles-Hillel
- Pediatric Pulmonary Unit and Cystic Fibrosis Center, Hadassah Medical Center, Jerusalem, Israel.,Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel.,The Wohl Institute for Translational Medicine, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Liora H Soesman
- Department of Pediatrics, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Silwan Miari
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Oded Breuer
- Pediatric Pulmonary Unit and Cystic Fibrosis Center, Hadassah Medical Center, Jerusalem, Israel.,Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Reuven Tsabari
- Pediatric Pulmonary Unit and Cystic Fibrosis Center, Hadassah Medical Center, Jerusalem, Israel.,Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Hila Elyashar-Earon
- Pediatric Pulmonary Unit and Cystic Fibrosis Center, Hadassah Medical Center, Jerusalem, Israel
| | | | - Aline B Sprikkelman
- Department of Pediatric Pulmonology and Pediatric Allergology, University of Groningen, Groningen, The Netherlands
| | - Joel Reiter
- Pediatric Pulmonary Unit and Cystic Fibrosis Center, Hadassah Medical Center, Jerusalem, Israel.,Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - David Zangen
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel.,Pediatric Endocrinology Unit, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Eran Lavi
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel.,Pediatric Endocrinology Unit, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Eitan Kerem
- Pediatric Pulmonary Unit and Cystic Fibrosis Center, Hadassah Medical Center, Jerusalem, Israel.,Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Malena Cohen-Cymberknoh
- Pediatric Pulmonary Unit and Cystic Fibrosis Center, Hadassah Medical Center, Jerusalem, Israel.,Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
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Zangen D, Florsheim N, Lavi E, Kerem L, Renbaum P, Cahan R, Libdeh AA, Levi-Lahad E, Mendelsohn EE. PMON193 Reactive oxygen species in the development of gonadal failure in late-onset transaldolase deficiency. J Endocr Soc 2022. [PMCID: PMC9625756 DOI: 10.1210/jendso/bvac150.1289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background Deficiency in Transaldolase, an essential enzyme in regulating NADPH and ribose 5-phosphate production, has been reported in only 39 patients to date. Most patients present already prenatally/neonatally with intra uterine growth retardation, hepato(spleno)megaly and consequent liver failure, anemia, thrombocytopenia, dysmorphic facial features, cardiac and skin abnormalities and hypergonadotropic hypogonadism in cases of late-onset presentation. The mechanism underlying gonadal dysfunction is not fully understood. Clinical case, methods and results A 15y old male from an Indian-Jewish background, with atrial-septal-defect, renal tubulopathy, mild facial dysmorphism and transient liver enzymes abnormalities presented with absence of pubertal development. His gonadotropins levels were elevated (LH – 22 IU/L, FSH 103 IU/L) while testosterone was low. Whole exome sequencing revealed homozygous variant in a novel T167M missense mutation in TALDO1 (transaldolase) gene whereas both parents were heterozygote carriers. Proteine structure analysis indicate that Threonine 167 is part of transaldolase catalytic site and critical for its function. As transaldolase activity is required for nucleic acids production, NADPH synthesis and reduction of cellular Reactive Oxygen Species (ROS) we measured the ROS accumulation using 2′,7′-dichlorodihydrofluorescein diacetate, in fibroblasts derived from the patient and normal controls. The affected patient's fibroblasts showed a significantly increased accumulation of ROS (207%, P=0.007), compared to controls indicating an increased susceptibility to oxidative stress. Conclusion The novel T167M missense mutation in the transaldolase (TALDO1) gene causes a unique clinical presentation including a relative mild liver involvement and hypergonadotrophic hypogonadism. The compromised TALDO1 activity in preventing cellular ROS accumulation in actual patient's fibroblasts is shown here for the first time and may indicate the therapeutic use of antioxidants in all patients with TALDO1 dysfunction. The high expression of TALDO1 in the testis and the gonadal failure suggests its tissue specific requirement in preventing the accumulation of ROS during steroidogenesis. Presentation: Monday, June 13, 2022 12:30 p.m. - 2:30 p.m.
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Cahn R, Zangen D, Mendelsohn E, florsheim N, Berman BP, Abu-Libdeh A, Lavi E. ODP055 The methylation pattern of a unique Bilateral para-overian Adrenal Rest Tumor in a girl with Nicotinamide Nucleotide Transhydrogenase mutation. J Endocr Soc 2022. [PMCID: PMC9627243 DOI: 10.1210/jendso/bvac150.134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Background Patients with NNT (Nicotinamide Nucleotide Transhydrogenase) gene mutations, a rare cause of glucocorticoid and mineralocorticoid deficiency require hormone replacement therapy. Adrenal Rest Tumor (ART) in females, reported so far only in noncompliant patients with congenital adrenal hyperplasia and elevated ACTH levels, is very rare (<20 cases world-wide). This study characterizes the pathophysiology, the molecular ontogeny and methylation analysis of a unique ART in a female with adrenal failure due to the G200S mutation in NNT Clinical presentation and Method: A 15-year-old girl, with homozygous G200S NNT-mutation followed for adrenal insufficiency reappeared to follow-up with severe virilization and elevated serum testosterone (28.3 nmol/l) and ACTH (> 1500 pmol/l). Pelvic MRI and Ultrasound demonstrated one sided paraovarian round tumor with pathological vascularization. Laparoscopic exploration revealed bilateral para ovarian mesosalpinx masses involving the serosa of the Fallopian tube, (3 and 1 cm in diameter). The testosterone level normalized within one day after surgical removal of those masses (0.2 nmol/l). Results Histopathology demonstrated a pattern of adrenal rest tissue with strong intracellular positive staining for adrenal markers such as SF-1, calretinin, MART1, inhibin and the pituitary marker ACTH. The staining for ovarian characteristic markers such as PAX 8 was negative. Studying mRNA extracted from the tissue by RT-PCR revealed the positive Gene expression of Cyp17a1, Cyp21a2 and Mc2r cDNA but not Pomc suggesting adrenal but not pituitary origin of the tissue. We further profiled the epigenomic profile of several adrenal rest tumors from both ovarian and testes origins using the Infinium Methylation EPIC array. We characterized the adrenal-specific features by comparing the tumors from the two different originating sites to published methylation array data on healthy adrenal tissue. We further investigated cancer-specific methylation changes to identify activated cancer pathways, and used the methylation arrays to identify somatic copy number alterations. Finally, we analyzed the likely developmental origin of these tumors by comparing to published methylation array data of developmental and adult reproductive tissues. Conclusion This study exemplifies severe virilization that resulted from a unique and rare type of ART in ovarian related tissue that was caused by incompliance to treatment in a patient with NNT gene mutation. The laparoscopic surgical findings indicate that imaging techniques may be insufficient in identification of such rest tumors and call for laparoscopy when clinical findings are suggestive. An early detection of this tumor could preserve fertility. Using histopathology markers cDNA studies and epigenomic profiling by methylation studies, our study shows for the first time that female ART originates from adrenal cells. The growth of a functional androgen producing "tumor" indicates that functional NNT protein is NOT required for androgen synthesis in contrast to glucocorticoids and that a zona reticularis similar tissue in ART is responsive to ACTH stimulation. Presentation: No date and time listed
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5
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Tsabari R, Simchovitz E, Lavi E, Eliav O, Avrahami R, Ben-Sasson S, Dor T. Erratum to "Safety and clinical outcome of tamoxifen in Duchenne Muscular Dystrophy" [Neuromuscular Disorders 31 (2021) 803-813]. Neuromuscul Disord 2022; 32:e5-e7. [PMID: 35277324 DOI: 10.1016/j.nmd.2022.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Reuven Tsabari
- Pediatric Pulmonology Unit, Hadassah Medical Center, The Faculty of Medicine, Hebrew University of Jerusalem, Israel
| | - Elana Simchovitz
- Physiotherapy Department, Hadassah Medical Center, The Faculty of Medicine, Hebrew University of Jerusalem, Israel
| | - Eran Lavi
- Pediatric Endocrinology Unit, Hadassah Medical Center, The Faculty of Medicine, Hebrew University of Jerusalem, Israel
| | - Osnat Eliav
- Pediatric Neurology Unit, Hadassah Medical Center, The Faculty of Medicine, Hebrew University of Jerusalem, Israel
| | - Ran Avrahami
- Pediatric Neurology Unit, Hadassah Medical Center, The Faculty of Medicine, Hebrew University of Jerusalem, Israel
| | - Shmuel Ben-Sasson
- Department of Developmental Biology and Cancer Research, Institute for Medical Research Israel-Canada (IMRIC), The Faculty of Medicine, Hebrew University of Jerusalem, Israel
| | - Talya Dor
- Physiotherapy Department, Hadassah Medical Center, The Faculty of Medicine, Hebrew University of Jerusalem, Israel.
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6
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Lavi E, Maree A, Eisenstein EM, Wexler I, Berger I, Berkun Y. Increased prevalence of attention-deficit hyperactivity disorder symptomatology in patients with familial Mediterranean fever. Mod Rheumatol 2021; 32:422-426. [PMID: 34758078 DOI: 10.1093/mr/roab009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 04/19/2021] [Accepted: 07/21/2021] [Indexed: 11/14/2022]
Abstract
OBJECTIVES Previous studies suggest that exposure to inflammation in infancy may increase the risk for attention-deficit and hyperactivity disorder (ADHD). We studied the ADHD manifestations among 124 familial Mediterranean fever (FMF) patients and examined the relationship between FMF patient characteristics and ADHD. METHODS Clinical, demographic, and genetic data were abstracted from patients' medical records and supplemented by information obtained during clinic visits. ADHD manifestations were assessed using the Diagnostic and Statistical Manual of Mental Disorders (5th ed.) questionnaire. RESULTS ADHD was diagnosed in 42 (32.8%) FMF patients, a rate significantly higher than in unselected populations (∼8%). A majority (n = 27, 64.3%) had combined inattentive, hyperactive-impulsive manifestations. Eight (19%) had predominantly hyperactive-impulsive, and seven (16.6%) had predominantly inattentive symptoms. FMF patients with severe manifestations reported more ADHD symptoms. FMF patients with ADHD symptoms were less adherent to their treatment regimen, with only 61.9% of the patients with ADHD symptoms adhering to colchicine therapy compared to 92.7% of the patients without ADHD symptoms. CONCLUSION The high prevalence of ADHD characteristics in children with FMF may support the neuroimmune hypothesis that chronic inflammation increases the risk for ADHD. Children with FMF should be screened for ADHD as its presence may adversely affect adherence to treatment.
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Affiliation(s)
- Eran Lavi
- Department of Pediatrics, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.,Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Aus Maree
- Department of Pediatrics, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Eli M Eisenstein
- Department of Pediatrics, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Isaiah Wexler
- Department of Pediatrics, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.,Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Itai Berger
- Pediatric Neurology, Assuta-Ashdod University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Yackov Berkun
- Department of Pediatrics, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.,Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
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7
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Lavi E, Shafrir A, Halloun R, Basel I, Eventov Friedman S, Abu-Libdeh A, Shoob H, Stein-Zamir C, Zangen DH. Eligibility for growth hormone therapy in children born small for gestational age is substantially lower than expected. Clin Endocrinol (Oxf) 2021; 95:308-314. [PMID: 33887065 DOI: 10.1111/cen.14489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Revised: 04/08/2021] [Accepted: 04/18/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Growth hormone therapy is indicated for children who are both born 'small for gestational age' (SGA) and do not achieve adequate catch-up growth (ACUG). OBJECTIVE To evaluate the actual incidence of infants born SGA and their actual ACUG. METHODS Birth weight data from the newborn registry at two hospitals were analysed during four consecutive years. SGA was defined according to WHO parameters and the corresponding Israeli criteria. Follow-up measurements of height and weight were abstracted from either the Ministry of Health-child growth follow-up centres, or their paediatrician clinic. ACUG was declared when the height reached was above -2.5 or -2 standard deviations (SDS) from the mean for age and gender. RESULTS Out of 43 307, only 524 babies in the cohort (1.2%) were SGA (52% of expected). This finding was consistent annually. Out of the 446 SGA born children with available growth data (85%) during 4-8 years, 405 children (90.8%) reached a height greater than -2SDS and 428 (96%!) reached a height greater than -2.5 SDS. Term children had higher rate of ACUG achievement as compared to preterm 97.2% vs 86.8% (P < .001). Birth week and birth weight were also related to achievement of ACUG (P < .001). CONCLUSION This large representative, heterogeneous and Western Caucasian cohort indicates that the actual number of SGA newborns is nearly half of the expected and that the actual prevalence of ACUG is also significantly higher than previously reported. These findings may have an impact on morbidity, health cost planning and growth hormone requirements in SGA babies.
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Affiliation(s)
- Eran Lavi
- Division of pediatric endocrinology, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Asher Shafrir
- Division of pediatric endocrinology, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Rana Halloun
- Division of pediatric endocrinology, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Itai Basel
- Division of pediatric endocrinology, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Smadar Eventov Friedman
- Department of Neonatology, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Abdulsalam Abu-Libdeh
- Division of pediatric endocrinology, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Hanna Shoob
- Jerusalem District Health Office, Ministry of Health, The Hebrew University, Hadassah, Jerusalem, Israel
| | - Chen Stein-Zamir
- Jerusalem District Health Office, Ministry of Health, The Hebrew University, Hadassah, Jerusalem, Israel
| | - David Haim Zangen
- Division of pediatric endocrinology, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
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8
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Cahn R, Mendelson EE, Lavi E, Sharaf M, Florsheim N, Atlan KA, Bauman D, Zangen D. Severe Virilization in a Girl With the Homozygous G200SNicotinamide Nucleotide Transhydrogenase Mutation Is Surprisingly Caused by Rare Bilateral Para-Overian Adrenal Rest Tumors. J Endocr Soc 2021. [PMCID: PMC8089323 DOI: 10.1210/jendso/bvab048.318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Abstract
Background: Patients with NNT (Nicotinamide Nucleotide Transhydrogenase) gene mutations, a rare cause of glucocorticoid and mineralocorticoid deficiency require hormone replacement therapy. Adrenal Rest Tumor (ART) in females is very rare (<20 cases world-wide) and was reported only in noncompliant patients with congenital adrenal hyperplasia having extremely elevated ACTH levels. This study characterizes the clinical characteristics, the pathophysiology and the molecular ontogeny of a unique ART in a female with adrenal failure due to the G200S mutation in NNT.
Clinical presentation and Method: A 15-year-old girl, with homozygous G200S NNT-mutation that caused adrenal insufficiency reappeared to follow-up after several years with severe virilization and elevated serum testosterone (28.3 nmol/l) and ACTH (> 1500 pmol/l) levels. Pelvic MRI and Ultrasound demonstrated one sided para-ovarian round tumor with pathological vascularization. Laparoscopic exploration revealed bilateral para-ovarian mesosalpinx masses involving the serosa of the Fallopian tube (3 and 1 cm in diameter); the testosterone level normalized within one day after removal of those masses (0.2 nmol/l).
Results: Histopathology demonstrated a pattern of adrenal rest tissue with strong intracellular positive staining for adrenal markers such as SF-1, calretinin, MART1, inhibin and the pituitary corticotroph marker-ACTH. The staining for ovarian characteristic markers such as PAX 8 was negative. Studying mRNA extracted from the tissue by RT-PCR revealed the presence of CYP17A1, CYP21A2 and MC2R (ACTH receptor) cDNA confirming typical adrenocortical transcriptional pattern in the tissue. cDNA of POMC was not detected suggesting that in spite of dense ACTH staining the tissue is not classically originated from pituitary corticotrophs. Methylome studies to further characterise the tissue are underway.
Conclusion: This study exemplifies severe virilization that resulted from a unique and rare type of ART in ovarian related tissue that was caused by incompliance to treatment in a patient with NNT gene mutation. Given the ubiquitous expression of NNT and its reported pathophysiology as free radicals scavenger in all adrenocortical layers, it is surprising to have high ACTH induced severe virilization in spite of severe NNT dysfunction and adrenal insufficiency. This study may indicate timely testosterone screening in females with NNT mutation and when increased they should probably be laparoscopically surveyed for ART even when not detected by imaging. How NNT mutation damages mineralo and glucocorticoid secreting cells while androgen secreting cells are rescued is a theme for further studies.
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Affiliation(s)
- Ranit Cahn
- Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | | | - Eran Lavi
- Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Muna Sharaf
- Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | | | | | - Dvora Bauman
- Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - David Zangen
- Hadassah Hebrew University Medical Center, Jerusalem, Israel
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Lavi E, Cohen A, Dor T, Tsabari R, Zangen D. Growth Hormone Therapy for Children With Duchenne Muscular Dystrophy and Glucocorticoid Induced Short Stature. J Endocr Soc 2021. [PMCID: PMC8090397 DOI: 10.1210/jendso/bvab048.1455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Background: Duchenne Muscular Dystrophy (DMD) is the most common form of inherited muscle disease in childhood. DMD patients have severe growth retardation due to several reasons including chronic treatment with glucocorticoid (GC). Data regarding the efficacy and safety of Recombinant Growth Hormone (rGH) treatment in DMD patients is very limited. The aim of this study is to evaluate efficacy and safety of growth hormone treatment in 4 DMD boys with glucocorticoid induced growth failure. Methods and Results: 4 prepubertal patients with DMD on high dose of GC (Deflazecort or Prednisone) at an age range between 12-13.6 years and significantly delayed bone age (8.5-11 years) were studied. rhGH was subcutaneously administered at a dose of 0.033 mg/kg/d for a duration of 12-18 months. Pretreatment annual growth rate of the 4 patients (0, 3,2.5, 1.5 cm/yr) improved during treatment (3.8, 7.8, 7.2, 3.3 cm/yr respectively). While height SD improved in 2 patients: -2.74 and -2.96 height SD to -2.52 and -2.64 height SD on rGH therapy, In the other two patients pretreatment continuous decline in height SD was arrested. Motor function decline was similar pre-growth hormone and during treatment. Cardiopulmonary function measured by ejection fraction and forced vital capacity was unchanged during the treatment period. Conclusions: This report of growth hormone therapy in DMD patients revealed an improved prepubertal growth velocity without detrimental effects observed on neuromuscular and cardiopulmonary function. Larger randomized control studies are required to prove safety and efficacy of this treatment in DMD patients.
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Affiliation(s)
- Eran Lavi
- Hadassah Hebrew University Medical Center, Jerusalem, Israel., Jerusalem, Israel
| | - Amitay Cohen
- Hadassah Hebrew University Medical Center, Jerusalem, Israel., Jerusalem, Israel
| | - Talya Dor
- Hadassah Hebrew University Medical Center, Jerusalem, Israel., Jerusalem, Israel
| | - Reuven Tsabari
- Hadassah Hebrew University Medical Center, Jerusalem, Israel., Jerusalem, Israel
| | - David Zangen
- Hadassah Hebrew University Medical Center, Jerusalem, Israel
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10
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Faingelernt Y, Hershkovitz E, Abu-Libdeh B, Abedrabbo A, Abu-Rmaileh Amro S, Zarivach R, Zangen D, Lavi E, Haim A, Parvari R, Abu-Libdeh A. Aldosterone synthase (CYP11B2) deficiency among Palestinian infants: Three novel variants and genetic heterogeneity. Am J Med Genet A 2021; 185:1033-1038. [PMID: 33438832 DOI: 10.1002/ajmg.a.62056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 11/22/2020] [Accepted: 12/12/2020] [Indexed: 11/11/2022]
Abstract
Aldosterone synthase deficiency (ASD) is a rare potentially life-threatening genetic disorder that usually presents during infancy due to pathogenic variants in the CYP11B2 gene. Knowledge about CYP11B2 variants in the Arab population is scarce. Here, we present and analyze five Palestinian patients and their different novel pathogenic variants. Data on clinical presentation, electrolytes, plasma renin activity, and steroid hormone levels of five patients diagnosed with ASD were summarized. Sequencing of the CYP11B2 gene exons was followed by evolutionary conservation analysis and structural modeling of the variants. All patients were from highly consanguineous Palestinian families. The patients presented at 1-4 months of age with recurrent vomiting, poor weight gain, hyponatremia, hyperkalemia, and low aldosterone levels. Genetic analysis of the CYP11B2 gene revealed three homozygous pathogenic variants: p.Ser344Profs*9, p.G452W in two patients from an extended family, and p.Q338stop. A previously described pathogenic variant was found in one patient: p.G288S. We described four different CYP11B2 gene pathogenic variants in a relatively small population. Our findings may contribute to the future early diagnosis and therapy for patients with ASD among Arab patients who present with failure to thrive and compatible electrolyte disturbances.
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Affiliation(s)
- Yaniv Faingelernt
- Department of Pediatrics, Soroka University Medical Center, Beer-Sheva, Israel.,Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Eli Hershkovitz
- Department of Pediatrics, Soroka University Medical Center, Beer-Sheva, Israel.,Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Bassam Abu-Libdeh
- Department of Pediatrics, Makassed Hospital & Al-Quds Medical School, East Jerusalem, Palestine.,Genetics Department, Makassed Hospital & Al-Quds Medical School, East Jerusalem, Palestine
| | - Amal Abedrabbo
- Department of Pediatrics, Makassed Hospital & Al-Quds Medical School, East Jerusalem, Palestine
| | - Sara Abu-Rmaileh Amro
- Department of Pediatrics, Makassed Hospital & Al-Quds Medical School, East Jerusalem, Palestine
| | - Raz Zarivach
- The National Institute for Biotechnology in the Negev, Ben-Gurion University of the Negev, Beer Sheva, Israel.,Department of Life Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - David Zangen
- Division of Pediatric Endocrinology, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Eran Lavi
- Division of Pediatric Endocrinology, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Alon Haim
- Department of Pediatrics, Soroka University Medical Center, Beer-Sheva, Israel.,Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Ruti Parvari
- The National Institute for Biotechnology in the Negev, Ben-Gurion University of the Negev, Beer Sheva, Israel.,Shraga Segal Department of Microbiology, Immunology and Genetics, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Abdulsalam Abu-Libdeh
- Department of Pediatrics, Makassed Hospital & Al-Quds Medical School, East Jerusalem, Palestine.,Division of Pediatric Endocrinology, Hadassah Hebrew University Medical Center, Jerusalem, Israel
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11
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Levy-Khademi F, Zeligson S, Lavi E, Klopstock T, Chertin B, Avnon-Ziv C, Abulibdeh A, Renbaum P, Rosen T, Perlberg-Bengio S, Zahdeh F, Behar DM, Levy-Lahad E, Zangen D, Segel R. The novel founder homozygous V225M mutation in the HSD17B3 gene causes aberrant splicing and XY-DSD. Endocrine 2020; 69:650-654. [PMID: 32372306 DOI: 10.1007/s12020-020-02327-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Accepted: 04/22/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE Mutations in the gene HSD17B3 encoding the 17-beta hydroxysteroid dehydrogenase 3 enzyme cause testosterone insufficiency leading to XY disorders of sex development. In this study the clinical and molecular characteristics of three patients from consanguineous families are elucidated. METHODS We identified three patients from two unrelated families with XY DSD and a novel homozygous HSD17B3:c. 673G>A mutation. The effect of the mutation on splicing was determined in RNA extracted from the testis of one patient. RESULTS Three patients presented at ages 0.1, 8 and 0.7 years with ambiguous genitalia and an XY Karyotype. Endocrine workup showed normal cortisol and mineralocorticoid levels with a low testosterone/androstenedione ratio. Whole-exome sequencing, carried out in the first family, revealed a homozygous novel mutation in the HSD17B3 gene: c. 673G>A, p. V225M. The same mutation was found by Sanger sequencing in the third unrelated patient. Haplotype analysis of a 4 Mb region surrounding the HSD17B3 gene on chromosome 9 revealed that the mutation resides on the same allele in all three patients. The mutation, being the first nucleic acid on exon 10, affects splicing and causes exon 10 skipping in one of our patients' testes. CONCLUSION The novel homozygous c. 673G>A, p. V225M mutation in the 17HSDB3 gene is likely a founder mutation and causes severe XY-DSD. It changes a conserved amino acid residue, and also alters 17HSDB3 gene transcription by causing skipping of exon 10, thereby contributing to an imbalance in the relevant protein isoforms and consequently, significant decreased 17HDSB3 enzymatic activity.
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Affiliation(s)
- Floris Levy-Khademi
- Division of Pediatric Endocrinology, Department of Pediatrics, Shaare Zedek Medical Center, Jerusalem, Israel.
- The Hebrew University School of Medicine, Jerusalem, Israel.
| | - Sharon Zeligson
- The institute of Medical Genetics, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Eran Lavi
- The Hebrew University School of Medicine, Jerusalem, Israel
- Division of Pediatric Endocrinology, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Tehila Klopstock
- The Hebrew University School of Medicine, Jerusalem, Israel
- The institute of Medical Genetics, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Boris Chertin
- The Hebrew University School of Medicine, Jerusalem, Israel
- Department of Pediatric Urology, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Carmit Avnon-Ziv
- Division of Pediatric Endocrinology, Department of Pediatrics, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Abdulsalam Abulibdeh
- The Hebrew University School of Medicine, Jerusalem, Israel
- Division of Pediatric Endocrinology, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Paul Renbaum
- The institute of Medical Genetics, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Tzvia Rosen
- The institute of Medical Genetics, Shaare Zedek Medical Center, Jerusalem, Israel
| | | | - Fouad Zahdeh
- The institute of Medical Genetics, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Doron M Behar
- Gene by Gene, Genomic Research Center, Houston, Texas, USA
| | - Ephrat Levy-Lahad
- The Hebrew University School of Medicine, Jerusalem, Israel
- Division of Pediatric Endocrinology, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - David Zangen
- The Hebrew University School of Medicine, Jerusalem, Israel.
- Division of Pediatric Endocrinology, Hadassah Hebrew University Medical Center, Jerusalem, Israel.
| | - Reeval Segel
- The Hebrew University School of Medicine, Jerusalem, Israel
- The institute of Medical Genetics, Shaare Zedek Medical Center, Jerusalem, Israel
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12
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Lavi E, Zighan M, Abu Libdeh A, Klopstock T, Weinberg-Shukron A, Renbaum P, Levy-Lahad E, Zangen D. A Unique Presentation of XY Gonadal Dysgenesis in Frasier Syndrome due to WT1 Mutation and a Literature Review. Pediatr Endocrinol Rev 2020; 17:302-307. [PMID: 32780953 DOI: 10.17458/per.vol17.2020.lzz.xygonadalfrasiersyndromewt1mutation] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Frasier syndrome (FS), a rare disease caused by inherited or de novo mutation in Wilm's Tumor suppressor gene 1 (WT1), is characterized by slow progressive nephropathy, XY gonadal dysgenesis (XY-DSD), and increased risk for gonadal tumors. Early childhood (1-6 years) nephropathy progresses with age to refractory nephrotic syndrome, and end-stage renal failure in late adolescence, when delayed puberty and/or primary amenorrhea are clinically evident. We report a unique case of FS presenting initially with primary amenorrhea at 16 years, without previous or concomitant renal damage. Only subsequently she developed an extremely late-onset nephropathy. Genetic analysis revealed the IVS9 + 5 G>A mutation in intron 9 of the WT1 gene. This clinical presentation and review of WT1 literature highlights the importance of considering FS in the differential diagnosis of patients with 46,XY disorders of Sexual development, even without nephropathy. Furthermore, the identification WT1 gene mutation prior to evident renal dysfunction indicates an immediate and close surveillance of renal function enabling an optimal and timely medical response.
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Affiliation(s)
- Eran Lavi
- Division of Pediatric Endocrinology, Hadassah Hebrew University Medical Center, Jerusalem, Israel, Hadassah Medical School, Hebrew University, Jerusalem, Israel
| | - Mahmud Zighan
- Division of Pediatric Endocrinology, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Abdulsalam Abu Libdeh
- Division of Pediatric Endocrinology, Hadassah Hebrew University Medical Center, Jerusalem, Israel, Hadassah Medical School, Hebrew University, Jerusalem, Israel
| | - Tehila Klopstock
- Institute of Medical Genetics, Shaare Zedek Medical Center, Jerusalem, Israel, Hadassah Medical School, Hebrew University, Jerusalem, Israel
| | - Ariella Weinberg-Shukron
- Institute of Medical Genetics, Shaare Zedek Medical Center, Jerusalem, Israel, Hadassah Medical School, Hebrew University, Jerusalem, Israel
| | - Pinchas Renbaum
- Institute of Medical Genetics, Shaare Zedek Medical Center, Jerusalem, Israel, Hadassah Medical School, Hebrew University, Jerusalem, Israel
| | - Ephrat Levy-Lahad
- Institute of Medical Genetics, Shaare Zedek Medical Center, Jerusalem, Israel, Hadassah Medical School, Hebrew University, Jerusalem, Israel
| | - David Zangen
- Division of Pediatric Endocrinology, Hadassah Hebrew University Medical Center, Jerusalem, Israel, E-mail:
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13
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Abstract
PURPOSE OF REVIEW Cystic fibrosis (CF) is commonly associated with compromised growth especially in severe cases when the pulmonary function (PFT) deteriorates. As growth optimization is an important aspect of CF management, this review will summarize the current knowledge on the prevalence of growth failure in CF patients, and focus on the mechanisms leading to poor growth, on the association of poor linear growth with reduced PFT and on recombinant human growth hormone (rhGH) therapy in CF patients. RECENT FINDINGS Despite the improvement in CF care in the last 2 decades, compromised linear growth is still quite prevalent. The pathophysiology of growth failure in CF is multifactorial. Malnutrition due to decreased energy intake increased energy expenditure and malabsorption of ingested nutrients secondary to pancreatic insufficiency, all probably play a major role in growth restriction. In addition, chronic inflammation characteristic of CF may contribute to growth failure via alteration in the GH-insulin-like growth factor 1 signaling and other changes in the growth plate. rhGH and new CFTR modulators may improve some growth parameters. SUMMARY Beyond optimizing nutrition and malabsorption, and controlling chronic inflammation, children with CF may benefit from the anabolic effects of rhGH therapy to improve their anthropometric parameters. Whether this translates into better PFT and improved long-term outcomes is yet to be determined.
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Affiliation(s)
- Eran Lavi
- Division of Pediatric Endocrinology, Pediatric Endocrinology Unit
| | - Alex Gileles-Hillel
- Pediatric Pulmonology and CF Unit, Department of Pediatrics
- The Wohl Institute for Translational Medicine, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - David Zangen
- Division of Pediatric Endocrinology, Pediatric Endocrinology Unit
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14
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Lavi E, Rekhtman D, Berkun Y, Wexler I. Sudden onset unexplained encephalopathy in infants: think of cannabis intoxication. Eur J Pediatr 2016; 175:417-20. [PMID: 26440670 DOI: 10.1007/s00431-015-2639-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2015] [Revised: 09/21/2015] [Accepted: 09/25/2015] [Indexed: 11/25/2022]
Abstract
UNLABELLED The use of cannabis as both a therapeutic agent and recreational drug is common, and its availability is increasing as a result of legalization in many countries. Among older children, the manifestations of cannabis intoxication are numerous and include both neurological and systemic manifestations that are frequently non-specific. There have been only a few reports detailing cannabis intoxication in infants and toddlers. We describe three infants who presented to the emergency department with encephalopathic signs without prominent systemic manifestations. During the initial interview of caregivers, no history of exposure to neurotoxic agents was obtained. All three patients were subsequently diagnosed with cannabis intoxication based on urine toxic screens for delta-9-tetrahydrocannabinol (THC). The infants recovered with supportive care that included fluids and monitoring. The non-specific symptomatology of cannabis intoxication in infants together with the wide differential for unexplained acute onset encephalopathy may delay diagnosis and lead to inappropriate procedures and interventions such as antimicrobial treatments and imaging studies. CONCLUSION Healthcare personnel of emergency rooms, urgent care centers, and general clinics should be aware of the potential risk of cannabis ingestion in young infants. A thorough medical history and toxic screen are warranted in all infants with unexplained decreased sensorium.
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Affiliation(s)
- Eran Lavi
- Department of Pediatrics, Hadassah-Hebrew University Medical Center, Mount Scopus, POB 24035, 91240, Jerusalem, Israel.
| | - David Rekhtman
- Department of Pediatrics, Hadassah-Hebrew University Medical Center, Mount Scopus, POB 24035, 91240, Jerusalem, Israel.
| | - Yackov Berkun
- Department of Pediatrics, Hadassah-Hebrew University Medical Center, Mount Scopus, POB 24035, 91240, Jerusalem, Israel.
| | - Isaiah Wexler
- Department of Pediatrics, Hadassah-Hebrew University Medical Center, Mount Scopus, POB 24035, 91240, Jerusalem, Israel.
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15
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Abstract
Here, we review current available literature regarding the effect of prior antibiotic treatment on outcomes of children hospitalized for community-acquired pneumonia (CAP). To date, no prospective trial has reported information regarding morbidity or mortality in this group of patients. Retrospective studies have provided evidence for the advantage of treatment with broad-spectrum antibiotics in children who failed prior antibiotic therapy. We discuss the changing epidemiology of CAP in the post PCV13 and Hib vaccines era and its relevance to the outcome of pediatric patients hospitalized for CAP. Current studies still report Streptococcus pneumoniae as the most common typical bacterial causative agent in pediatric CAP. However, in children who fail to respond to guideline directed antibiotic therapy, a non-pneumococcal, possibly one of several β-lactam resistant causative bacterial agents should be considered thus clarifying the advantage for broad-spectrum empirical antibiotic treatment in this group of patients.
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Affiliation(s)
- Eran Lavi
- Department of Pediatrics, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Oded Breuer
- Department of Pediatrics, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.
- Pediatric Pulmonology Unit, Hadassah-Hebrew University Medical Center, 91120, Jerusalem, Israel.
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16
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Lavi E, Berger I, Eisenstein E, Berkun Y. Increased prevalence of attention deficit hyperactivity disorder in children with Familial Mediterranean Fever. Pediatr Rheumatol Online J 2015. [PMCID: PMC4599840 DOI: 10.1186/1546-0096-13-s1-p131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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17
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Lavi E, Billig A, Amar D, Neuman R, Margulis A, Tzur T. Infection of tissue expander with Candida parapsilosis. Eplasty 2012; 12:ic7. [PMID: 22690264 PMCID: PMC3370404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Eran Lavi
- Department of Plastic and Reconstructive Surgery, Hadassah Medical Center, Hebrew University, Jerusalem, Israel,Correspondence:
| | - Allan Billig
- Department of Plastic and Reconstructive Surgery, Hadassah Medical Center, Hebrew University, Jerusalem, Israel
| | - Dalit Amar
- Department of Plastic and Reconstructive Surgery, Hadassah Medical Center, Hebrew University, Jerusalem, Israel
| | - Rami Neuman
- Department of Plastic and Reconstructive Surgery, Hadassah Medical Center, Hebrew University, Jerusalem, Israel
| | - Alex Margulis
- Department of Plastic and Reconstructive Surgery, Hadassah Medical Center, Hebrew University, Jerusalem, Israel
| | - Tomer Tzur
- Department of Plastic and Reconstructive Surgery, Hadassah Medical Center, Hebrew University, Jerusalem, Israel
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18
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Behera MK, Sharma A, Dutta S, Sharma S, Julka PK, Rath GK, Kil WJ, Ko C, Kaushal A, Warran K, Ning H, Camphausen K, Smart D, Vern-Gross TZ, McMullen KP, Case LD, Bourland JD, Ellis TL, Lawrence JA, Tatter SB, Shaw EG, Urbanic JJ, Chan MD, Jensen RL, Shrieve DC, Mohindra P, Robins HI, Tome WA, Howard SP, Chen C, Damek D, Gaspar LE, Ney D, Waziri A, Lillehei K, Kavanagh BD, Wang CC, Floyd S, Chang CH, Warnke P, Chio CC, Kasper E, Mahadevan A, Wong E, Jeyapalan S, Chen C, Mahajan A, Grosshans D, McAleer MF, Brown PD, Chintagumpala M, Vats T, Puduvalli V, Yock T, Schulder M, Herschmann Y, Ghaly M, Knisely J, Ghaly M, Kapur A, Schulder M, Knisely J, Goetz P, Lwu S, Ebinu J, Arayee M, Monsalves E, Laperriere N, Menard C, Bernstein M, Zadeh G, Loganathan AG, Chan MD, Alphonse N, Peiffer AM, Johnson A, McMullen KP, Urbanic JJ, Saconn PA, Bourland JD, Munley MT, Shaw EG, Tatter SB, Ellis TL, Lwu S, Goetz P, Aryaee M, Monsalves E, Laperriere N, Menard C, Bernstein M, Zadeh G, Mahajan A, Lowe C, McAleer MF, Grosshans D, DeGroot J, Mark G, Vats T, Brown PD, Ruda R, Trevisan E, Magliola U, Bertero L, Bosa C, Ricardi U, Soffietti R, Rajappa P, Margetis K, Wernicke AG, Sherr DL, Lavi E, Fine RL, Schwartz T, Pannullo SC, Laack N, Blanchard M, Buckner J, Glass J, Andrews DW, Werner-Wasik M, Evans J, Lawrence YR, Shi W, Strauss I, Corn BW, Matceyevsky D, Alani S, Gez E, Shtraus N, Kanner AA, Spasic M, Choy W, Nagasawa D, Yang I, Noel M, Woolf E, Smith R, Castillo-Rojas P, Sorenson S, Smith K, Scheck AC, Han SJ, Oh MC, Sughrue ME, Rutkowski MJ, Aranda D, Barani IJ, Parsa AT, Redmond KJ, Horska A, Ishaq O, Ford E, McNutt T, Batra S, Kleinberg L, Wharam M, Mahone M, Terezakis S, Ryu S, Rock J, Movsas B, Mikkelsen T, Rosenblum M, Sabsevitz D, Bovi JA, Leo P, LaViolette P, Rand S, Mueller W, Phillips A, Venkatramani R, Olch A, Grimm J, Davidson T, Brown R, Dhall G, Finlay J, Wong K. RADIATION THERAPY. Neuro Oncol 2011. [DOI: 10.1093/neuonc/nor160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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19
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Santillan A, Zink W, Lavi E, Boockvar J, Gobin YP, Patsalides A. Endovascular embolization of cervical hemangiopericytoma with Onyx-18: case report and review of the literature. J Neurointerv Surg 2010; 3:304-7. [DOI: 10.1136/jnis.2010.003756] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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20
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Kasliwal MK, Anand VK, Lavi E, Schwartz TH. Endoscopic management of a rare case of nasal glioma in Meckel's cave in an adult: case report. ACTA ACUST UNITED AC 2010; 53:191-3. [PMID: 21132611 DOI: 10.1055/s-0030-1262812] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Nasal glioma or glial heterotopia is a rare embryologic anomaly that heralds its presence shortly after birth or in childhood. Nasal glioma in an adult is very rare, often asymptomatic and the occurrence of nasal glioma in Meckel's cave in an adult has not been previously reported. CASE REPORT The authors encountered a case of an incidentally diagnosed Meckel's cave nasal glioma in a 40-year-old male which was successfully excised by an endonasal endoscopic transmaxillary transpterygoid approach. CONCLUSION The occurrence of a nasal glioma in Meckel's cave an adult is very rare. Considering the deep skull base location, endonasal endoscopic surgery provides a minimal access technique to reach this location with excellent results.
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Affiliation(s)
- M K Kasliwal
- Department of Neurological Surgery, Weill Cornell Medical College, New York Presbyterian Hospital, 525 East 68th St., New York, NY 10065, USA
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21
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Lavi E, Rivkin L, Carmon M, Reissman P. Clozapine-induced colonic obstruction requiring surgical treatment. Isr Med Assoc J 2009; 11:385-386. [PMID: 19697595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Affiliation(s)
- Eran Lavi
- Department of Surgery, Shaare Zedek Medical Center, Jerusalem, Israel.
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22
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Howard BM, Hofstetter C, Wagner PL, Muskin ET, Lavi E, Boockvar JA. Transformation of a low-grade pineal parenchymal tumour to secondary pineoblastoma. Neuropathol Appl Neurobiol 2009; 35:214-7. [PMID: 19284482 DOI: 10.1111/j.1365-2990.2008.00985.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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23
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Abstract
In this study we have demonstrated that recombinant viruses carrying the amino acid mutations Q1067H, Q1094H, and L1114R were unable to induce fusion at neutral pH, replicated more efficiently in L2 cells, and that infection was delayed by ammonium chloride. These results suggest that the R120/R121 recombinants most likely use the endosomal pathway to enter cells. In this sense they are similar to the pH-dependent MHV-4 variant OBLV60. We were able to observe an attenuated virulence in vivo, despite the fact that our R120/R121 recombinants replicated to comparable (IC) or higher (IN) titers than the S4R29 recombinant in the brain. Preliminary results showed that the level of inflammation observed in infected mice is consistent with the attenuated virulence, but they cannot be explained by the high titers of replication.
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Affiliation(s)
- L De Groot
- Department of Microbiology, University of Pennsylvania School of Medicine, Philadelphia, PA 19104-6076, USA
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24
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Affiliation(s)
- A E Matthews
- Department of Microbiology, University of Pennsylvania, Philadelphia, PA, USA
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25
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Affiliation(s)
- T Schwartz
- Department of Pathology and Laboratory Medicine, University of Pennsylvania, School of Medicine, Philadelphia, PA, USA
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26
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Fu LI, Das Sarma J, Lavi E. Differential expression of tumor necrosis factor in primary glial cell cultures infected with demyelinating and non-demyelinating MHVs. Adv Exp Med Biol 2002; 494:663-8. [PMID: 11774542 DOI: 10.1007/978-1-4615-1325-4_98] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Affiliation(s)
- L I Fu
- Department of Pathology and Laboratory Medicine, University of Pennsylvania, School of Medicine, Philadelphia, PA, USA
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27
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Affiliation(s)
- M M Chua
- Department of Microbiology, University of Pennsylvania School of Medicine, Philadelphia, PA 19104-6076, USA
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28
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Affiliation(s)
- J Das Sarma
- Department of Pathology and Laboratory Medicine, University of Pennsylvania School of Medicine, Philadelphia, PA 19104-6076, USA
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29
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Navas S, Seo SH, Chua MM, Das Sarma J, Hingley ST, Lavi E, Weiss SR. Role of the spike protein in murine coronavirus induced hepatitis: an in vivo study using targeted RNA recombination. Adv Exp Med Biol 2002; 494:139-44. [PMID: 11774458 DOI: 10.1007/978-1-4615-1325-4_22] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Affiliation(s)
- S Navas
- Department of Microbiology, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA
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30
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Affiliation(s)
- J Das Sarma
- Department of Pathology and Laboratory Medicine, University of Pennsylvania, School of Medicine, Philadelphia, Pennsylvania, USA
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31
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Abstract
Murine hepatitis virus A59 infection of the central nervous system (CNS) results in CNS demyelination in susceptible strains of mice. In infected B-cell-deficient mice, demyelination not only occurred but was also more severe than in parental C57BL/6 animals. This increase may be due to the persistence of virus in the CNS in the absence of B cells. In mice lacking antibody receptors or complement pathway activity, virus did not persist yet demyelination was similar to parental mice. In infected RAG1(-/-) mice, moderately sized, typical demyelinating lesions were identified. Therefore, demyelination can occur in the absence of B and T cells.
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Affiliation(s)
- A E Matthews
- Department of Microbiology, University of Pennsylvania School of Medicine, Philadelphia 19104-6076, USA
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32
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Abstract
Atherosclerosis is associated with arterial deposition of low density lipoprotein (LDL) and lipoprotein(a), Lp(a). Both lipoproteins have been detected in atherosclerotic vessels; however, while LDL has been shown to be only blood-derived, it is not clear whether Lp(a) is also produced within the vessel wall. In the present investigation we studied gene expression of apo(a) and apoB in human blood vessels. Aorta, carotid arteries and liver specimens from 29 adult and pediatric autopsy cases were studied by RT-PCR and Southern blot analysis with primers and probes specific for apo(a), apoB and GAPDH (a control housekeeping gene). The mRNA of apo(a), but not apoB, was found within the vessel wall in both adult atherosclerotic arterial vessels and in pediatric non atherosclerotic vessels. Neither apo(a) nor apoB mRNA was detected in femoral veins. To verify the nature of the detected transcripts, we cloned the 162 base pair (bp) RT-PCR product derived from the arterial wall total RNA. Nucleotide sequencing revealed 100% homology with the apo(a) gene. Thus, while LDL in atherosclerotic arteries is exclusively blood-derived, the accumulation of Lp(a) within the artery may be due in part to in situ production of apo(a) within the vessel wall.
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Affiliation(s)
- L Fu
- Division of Neuropathology, University of Pennsylvania School of Medicine, 613 Stellar-Chance Laboratories, 422 Curie Blvd., Philadelphia, PA 19104-6100, USA
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33
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Jamieson DG, Fu L, Usher DC, Lavi E. Detection of lipoprotein(a) in intraparenchymal cerebral vessels: correlation with vascular pathology and clinical history. Exp Mol Pathol 2001; 71:99-105. [PMID: 11599915 DOI: 10.1006/exmp.2001.2384] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Serum levels of lipoprotein(a), Lp(a), have been shown to be associated with increased risk of atherosclerosis (AS) and AS-related diseases such as myocardial and ischemic cerebral infarcts (ICI). Lp(a) has been detected in the vascular wall of the aorta and coronary vessels, and we documented the presence of apo(a) in cerebral vessels of the Circle of Willis, associated with AS changes. In this study we further investigated and characterized the biochemical nature of Lp(a) detected in both large and small cerebral parenchymal vessels. Autopsy specimens of cerebral vessels of 51 patients were examined by immunohistochemistry with monoclonal antibodies against apo(a), apoB, and plasminogen. Lp(a) was detected in cerebral capillaries and arterioles. All of the 8 patients with ICI expressed Lp(a) in parenchymal vessels, generally (6/8) in both capillaries and arterioles. Of 43 patients without ICI only 25 had Lp(a) detected. Among the patients without ICI, there was a slightly increased incidence of parenchymal Lp(a) in those patients who had severe hypoxic brain damage (12/20) compared to those patients without severe hypoxic damage (9/23). Thus, the presence of Lp(a) in small cerebral parenchymal vessels may reflect the role of Lp(a) in ICI.
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Affiliation(s)
- D G Jamieson
- Department of Neurology, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania 19104-6100, USA
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34
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Das Sarma J, Fu L, Hingley ST, Lavi E. Mouse hepatitis virus type-2 infection in mice: an experimental model system of acute meningitis and hepatitis. Exp Mol Pathol 2001; 71:1-12. [PMID: 11502093 DOI: 10.1006/exmp.2001.2378] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Infection with mouse hepatitis virus (MHV) strain A59 produces acute hepatitis, encephalitis, and chronic demyelination in mice. However, little is known about a closely related strain, MHV-2, which is only weakly neurotropic. To better understand the molecular basis of neurotropism of MHVs, we compared the pathogenesis and genomic sequence of MHV-2 with that of MHV-A59. Intracerebral injection of MHV-2 into 4-week-old C57B1/6 mice produces acute meningitis and hepatitis without encephalitis or chronic inflammatory demyelination. Sequence comparison between MHV-2 and MHV-A59 reveals 94-98% sequence identity of the replicase gene, 83-95% sequence identity of genes 2a, 3, 5b, 6, and 7, and marked difference in the sequence of genes, 2b, 4, and 5a. This information provides the basis for further studies exploring the mechanism of viral neurotropism and virus-induced demyelination.
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Affiliation(s)
- J Das Sarma
- Division of Neuropathology, University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA
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35
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Goldberg SH, van der Meer P, Hesselgesser J, Jaffer S, Kolson DL, Albright AV, González-Scarano F, Lavi E. CXCR3 expression in human central nervous system diseases. Neuropathol Appl Neurobiol 2001; 27:127-38. [PMID: 11437993 DOI: 10.1046/j.1365-2990.2001.00312.x] [Citation(s) in RCA: 66] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The CXCR3 chemokine receptor, expressed on activated T lymphocytes, is seen within the central nervous system (CNS) in inflammatory conditions where a T-cell response is prominent. However, the distribution of CXCR3 in parenchymal CNS cells is unknown. Using a monoclonal antibody against CXCR3 and post-mortem tissue of patients with and without CNS pathology, we have determined its expression pattern. CXCR3 was found in subpopulations of cells morphologically consistent with astrocytes, particularly reactive astrocytes, and in cerebellar Purkinje cells. It was also detected in arterial endothelial and smooth muscle cells, particularly in areas associated with atherosclerotic plaques. CXCR3-positive astrocytes were particularly prominent in the CNS of HIV-positive patients, in patients with Multiple Sclerosis (MS), in ischaemic infarcts and in astrocytic neoplasms. Immunofluorescence studies of mixed adult primary glial cultures and fetal glial cultures also showed expression of CXCR3 in astrocytes. CXCR3 mRNA was detected in Purkinje cells by in situ hybridization with a CXCR3-specific probe. Thus, the predominant expression of CXCR3 in reactive astrocytes may indicate that it plays a role in the development of reactive gliosis in a variety of infectious, inflammatory, vascular and neoplastic processes in the CNS. The relationship between CXCR3 expression in astrocytes to its expression in Purkinje cells, endothelial cells and smooth muscle cells is yet to be determined.
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Affiliation(s)
- S H Goldberg
- Department of Pathology, University of Pennsylvania School of Medicine, Philadelphia, PA, USA
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36
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Navas S, Seo SH, Chua MM, Das Sarma J, Lavi E, Hingley ST, Weiss SR. Murine coronavirus spike protein determines the ability of the virus to replicate in the liver and cause hepatitis. J Virol 2001; 75:2452-7. [PMID: 11160748 PMCID: PMC114828 DOI: 10.1128/jvi.75.5.2452-2457.2001] [Citation(s) in RCA: 69] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Recombinant mouse hepatitis viruses (MHV) differing only in the spike gene, containing A59, MHV-4, and MHV-2 spike genes in the background of the A59 genome, were compared for their ability to replicate in the liver and induce hepatitis in weanling C57BL/6 mice infected with 500 PFU of each virus by intrahepatic injection. Penn98-1, expressing the MHV-2 spike gene, replicated to high titer in the liver, similar to MHV-2, and induced severe hepatitis with extensive hepatocellular necrosis. S(A59)R13, expressing the A59 spike gene, replicated to a somewhat lower titer and induced moderate to severe hepatitis with zonal necrosis, similar to MHV-A59. S4R21, expressing the MHV-4 spike gene, replicated to a minimal extent and induced few if any pathological changes, similar to MHV-4. Thus, the extent of replication and the degree of hepatitis in the liver induced by these recombinant viruses were determined largely by the spike protein.
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Affiliation(s)
- S Navas
- Department of Microbiology, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania 19104-6076, USA
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37
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Calida DM, Constantinescu C, Purev E, Zhang GX, Ventura ES, Lavi E, Rostami A. Cutting edge: C3, a key component of complement activation, is not required for the development of myelin oligodendrocyte glycoprotein peptide-induced experimental autoimmune encephalomyelitis in mice. J Immunol 2001; 166:723-6. [PMID: 11145641 DOI: 10.4049/jimmunol.166.2.723] [Citation(s) in RCA: 68] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Experimental autoimmune encephalomyelitis (EAE), an inflammatory demyelinating disease of the CNS, is regarded as an experimental model for multiple sclerosis. The complement has been implicated in the pathogenesis of multiple sclerosis. To clarify the role of C in mouse EAE, we immunized mice deficient in C3 (C3(-/-)) and their wild-type (C3(+/+)) littermates with myelin oligodendrocyte glycoprotein peptide 35-55. C3(-/-) mice were susceptible to EAE as much as the C3(+/+) mice were. No differences were found for the production of IL-2, IL-4, IL-12, TNF-alpha, and IFN-gamma between C3(+/+) and C3(-/-) mice. This finding shows that C3, a key component in C activation, is not essential in myelin oligodendrocyte glycoprotein peptide-induced EAE in mice.
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MESH Headings
- Animals
- Cell-Free System
- Cells, Cultured
- Complement Activation/genetics
- Complement C3/biosynthesis
- Complement C3/deficiency
- Complement C3/genetics
- Complement C3/physiology
- Cytokines/analysis
- Cytokines/metabolism
- Encephalomyelitis, Autoimmune, Experimental/genetics
- Encephalomyelitis, Autoimmune, Experimental/immunology
- Encephalomyelitis, Autoimmune, Experimental/pathology
- Immunohistochemistry
- Injections, Subcutaneous
- Interleukin-12/analysis
- Interleukin-12/biosynthesis
- Lymph Nodes/chemistry
- Lymph Nodes/cytology
- Lymph Nodes/immunology
- Mice
- Mice, Inbred C57BL
- Mice, Knockout
- Myelin Proteins
- Myelin-Associated Glycoprotein/administration & dosage
- Myelin-Associated Glycoprotein/immunology
- Myelin-Oligodendrocyte Glycoprotein
- Oligodendroglia/immunology
- Peptide Fragments/administration & dosage
- Peptide Fragments/immunology
- Spleen/chemistry
- Spleen/cytology
- Spleen/immunology
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Affiliation(s)
- D M Calida
- Department of Neurology, Department of Pathology and Laboratory Medicine, Division of Neuropathology, University of Pennsylvania, Philadelphia, PA 19104, USA
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38
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Constantinescu CS, Hilliard B, Ventura E, Wysocka M, Showe L, Lavi E, Fujioka T, Scott P, Trinchieri G, Rostami A. Modulation of susceptibility and resistance to an autoimmune model of multiple sclerosis in prototypically susceptible and resistant strains by neutralization of interleukin-12 and interleukin-4, respectively. Clin Immunol 2001; 98:23-30. [PMID: 11141323 DOI: 10.1006/clim.2000.4944] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Experimental autoimmune encephalomyelitis (EAE), an animal model for multiple sclerosis, is mediated by Th1 cells. The major Th1 inducer, IL-12, enhances EAE, while its blockade suppresses it. IL-4 suppresses EAE. Here, we determined IFN-gamma and IL-4 production by myelin basic protein-stimulated lymphocytes from prototypically EAE-susceptible SJL/J and EAE-resistant BALB/c mice, 9 days after immunization with spinal cord homogenate. While lymphocytes from SJL/J mice produce IFN-gamma and no IL-4, lymphocytes from BALB/c mice produce IL-4 and no IFN-gamma. Since early endogenous production of IL-12/IFN-gamma or IL-4 is linked to Th1 or Th2 responses, respectively, we determined whether neutralization of IL-12 or IL-4 at immunization modifies susceptibility or resistance to EAE. SJL/J mice given neutralizing anti-IL-12 mAb are protected from EAE. BALB/c mice given neutralizing anti-IL-4 mAb develop EAE, while those treated with control antibody remain resistant. These studies confirm the pivotal role of IL-12 in EAE development and show that endogenous IL-4 is important for determining the genetic resistance to EAE.
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Affiliation(s)
- C S Constantinescu
- Department of Neurology, University of Pennsylvania Medical Center, Philadelphia, Pennsylvania 19104,
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39
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Van Der Meer P, Goldberg SH, Fung KM, Sharer LR, González-Scarano F, Lavi E. Expression pattern of CXCR3, CXCR4, and CCR3 chemokine receptors in the developing human brain. J Neuropathol Exp Neurol 2001; 60:25-32. [PMID: 11202173 DOI: 10.1093/jnen/60.1.25] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Chemokine receptors are essential components of the immune and central nervous systems, but little is known about their distribution during development. We evaluated the distribution of 3 chemokine receptors: CXCR3, CXCR4, and CCR3 in the human developing brain. Of these, CXCR3 was the only receptor expressed in fetal brain at 26 wk of gestation and its expression was restricted to glial cells, endothelial cells, and the choroid plexus. Neuronal staining was only seen at term in the Purkinje cells of the cerebellum. CCR3 appeared only at term in both neurons and glial cells. The expression pattern of these 2 receptors in the late gestation and term resembled that of adults. CXCR4 could not be detected in the fetal brain on neurons nor on glial cells. By examining pediatric cases, we determined that CXCR4 expression commences sometimes between 3.5 and 4.5 yr. Two of the chemokine receptors examined, CCR3 and CXCR4, can be used as co-receptor together with CD4 for HIV entry, but neither was expressed during the second trimester of pregnancy. Our findings suggest that it is unlikely that CCR3 or CXCR4 play a major role in HIV-1 transmission in the fetal brain before 37 wk of gestation.
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Affiliation(s)
- P Van Der Meer
- Department of Pathology and Laboratory Medicine (Neuropathology), University of Pennsylvania Medical Center, Philadelphia, USA
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40
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Fung KM, Forman MS, Cucchiara B, ZuLinska E, Wallis-Crespo M, Lavi E. July 2000: A 70 year old with rigidity, decreased ocular movements, and dementia. Brain Pathol 2001; 11:119-20, 125. [PMID: 11145197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023] Open
Abstract
The July Case of the Month (COM): A 70 year old male presented with a four year history of cognitive decline, difficulty expressing himself, and an increasingly unsteady gait with numerous falls. At presentation he was wheel-chair bound. Examination showed some slowing of speech, mild memory impairment, but normal cranial nerves. Spastic weakness and brisk reflexes were also noted, with bilateral ankle clonus. MRI scans were normal. Four years later he was admitted with a urinary tract infection and was mute with severely impaired ocular motility. He died 18 months later and autopsy showed the classic neuropathological findings of typical Progressive supranuclear palsy, including tau-positive glial inclusions.
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Affiliation(s)
- K M Fung
- Department of Pathology and Laboratory Medicine, Hospital of the University of Pennsylvania, Philadelphia, USA
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41
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Calida D, Kremlev S, Fujioka T, Hilliard B, Ventura E, Constantinescu C, Lavi E, Rostami A. EXPERIMENTAL ALLERGIC NEURITIS IN THE SJL/J MOUSE: INDUCTION OF SEVERE AND REPRODUCIBLE DISEASE WITH BOVINE PERIPHERAL NERVE MYELIN AND PERTUSSIS TOXIN WITH OR WITHOUT INTERLEUKIN‐12. J Peripher Nerv Syst 2000. [DOI: 10.1111/j.1529-8027.2000.22-44.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Dm Calida
- Journal of Neuroimmunology 107: 1–7, 2000. Reprinted with permission from Elsevier Science BV
| | - Sg Kremlev
- Journal of Neuroimmunology 107: 1–7, 2000. Reprinted with permission from Elsevier Science BV
| | - T Fujioka
- Journal of Neuroimmunology 107: 1–7, 2000. Reprinted with permission from Elsevier Science BV
| | - B Hilliard
- Journal of Neuroimmunology 107: 1–7, 2000. Reprinted with permission from Elsevier Science BV
| | - E Ventura
- Journal of Neuroimmunology 107: 1–7, 2000. Reprinted with permission from Elsevier Science BV
| | - Cs Constantinescu
- Journal of Neuroimmunology 107: 1–7, 2000. Reprinted with permission from Elsevier Science BV
| | - E Lavi
- Journal of Neuroimmunology 107: 1–7, 2000. Reprinted with permission from Elsevier Science BV
| | - A. Rostami
- Journal of Neuroimmunology 107: 1–7, 2000. Reprinted with permission from Elsevier Science BV
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42
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van der Meer P, Ulrich AM, Gonźalez-Scarano F, Lavi E. Immunohistochemical analysis of CCR2, CCR3, CCR5, and CXCR4 in the human brain: potential mechanisms for HIV dementia. Exp Mol Pathol 2000; 69:192-201. [PMID: 11115360 DOI: 10.1006/exmp.2000.2336] [Citation(s) in RCA: 142] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The CXC chemokine receptor CXCR4 was the first molecule identified as a coreceptor working in conjunction with CD4 to mediate cellular entry for the human immunodeficiency virus (HIV-1). Since that original discovery, 11 other seven-mtransmembrane domain molecules, many of which are chemokine receptors, have been shown to facilitate HIV entry into cells. These include CCR5, CCR3, CCR2, CCR1, CCR8, CX3CR1, STRL33 (BONZO), GPR15 (BOB), GPR1, US28, and APJ. In studies done by this and other labs, CCR3, CCR5, and CXCR4 have been identified in CNS microglia and several laboratories, including ours, have shown that CXCR4 is expressed in neurons. Neuronal expression of CCR2, CCR3, and CCR5 has been less consistent. We performed a semiquantitative immunohistochemical analysis of the expression of CCR2, CCR3, CCR5, and CXCR4 in 23 regions of the brain and in two sections of the spinal cord. Hippocampal neurons were positive for CCR2, CCR3, and CXCR4, but not for CCR5. In other regions of the brain, neurons, and glial cells reacted with anti-CCR2, anti-CCR3, and anti-CXCR4 antibodies, whereas only glial cells (primarily microglia) were positive for CCR5. The areas of highest expression, however, seem to be subcortical regions and the limbic system. The limbic system plays a key role in memory, and the presence of CXCR4-which can bind the viral envelope protein gp120-min a subset of neurons from this system may play a role in the development of HIV-related dementia.
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Affiliation(s)
- P van der Meer
- Department of Pathology and Laboratory Medicine, University of Pennsylvania School of Medicine, Philadelphia 19104-6100, USA
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43
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Calida D, Kremlev S, Fujioka T, Hilliard B, Ventura E, Constantinescu C, Lavi E, Rostami A. EXPERIMENTAL ALLERGIC NEURITIS IN THE SJL/J MOUSE: INDUCTION OF SEVERE AND REPRODUCIBLE DISEASE WITH BOVINE PERIPHERAL NERVE MYELIN AND PERTUSSIS TOXIN WITH OR WITHOUT INTERLEUKIN-12. J Peripher Nerv Syst 2000. [DOI: 10.1046/j.1529-8027.2000.00022-44.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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44
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Abstract
Demyelination is the pathologic hallmark of the human immune-mediated neurologic disease multiple sclerosis, which may be triggered or exacerbated by viral infections. Several experimental animal models have been developed to study the mechanism of virus-induced demyelination, including coronavirus mouse hepatitis virus (MHV) infection in mice. The envelope spike (S) glycoprotein of MHV contains determinants of properties essential for virus-host interactions. However, the molecular determinants of MHV-induced demyelination are still unknown. To investigate the mechanism of MHV-induced demyelination, we examined whether the S gene of MHV contains determinants of demyelination and whether demyelination is linked to viral persistence. Using targeted RNA recombination, we replaced the S gene of a demyelinating virus (MHV-A59) with the S gene of a closely related, nondemyelinating virus (MHV-2). Recombinant viruses containing an S gene derived from MHV-2 in an MHV-A59 background (Penn98-1 and Penn98-2) exhibited a persistence-positive, demyelination-negative phenotype. Thus, determinants of demyelination map to the S gene of MHV. Furthermore, viral persistence is insufficient to induce demyelination, although it may be a prerequisite for the development of demyelination.
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Affiliation(s)
- J Das Sarma
- Division of Neuropathology, Department of Pathology and Laboratory Medicine, University of Pennsylvania, Philadelphia 19104, USA
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45
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Abstract
This study was designed to characterize the severity of tissue damage in experimental spinal cord injury using magnetization transfer (MT) histogram analysis. Seven Sprague-Dawley rats were subjected to laminectomy and standard weight-drop injury to the spinal cord (four rats at 15 cm drop-height and three rats at 2.5 cm). Three control animals underwent laminectomy without weight-drop. After sacrifice, the animals were scanned at 1.9 T with a pulsed off-resonance MT technique. Following magnetic resonance (MR) imaging, the cords were embedded in paraffin and sectioned into 5-microm sections for semiquantitative histopathological analysis. Composite histograms were generated using data spanning an axial distance of 3 cm centered on the injury site. MT histogram parameters, such as the amount of tissue with statistical correspondence to normal white matter, were highly predictive of histopathological results, including myelination state and neurofilament damage. Less correlation with edema was observed, suggesting that the technique was most sensitive to true tissue alteration.
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Affiliation(s)
- J C McGowan
- Department of Radiology, University of Pennsylvania, Philadelphia 19104, USA.
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46
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Calida DM, Kremlev SG, Fujioka T, Hilliard B, Ventura E, Constantinescu CS, Lavi E, Rostami A. Experimental allergic neuritis in the SJL/J mouse: induction of severe and reproducible disease with bovine peripheral nerve myelin and pertussis toxin with or without interleukin-12. J Neuroimmunol 2000; 107:1-7. [PMID: 10808045 DOI: 10.1016/s0165-5728(00)00249-6] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
We report a reproducible model of experimental allergic neuritis (EAN) with severe clinical signs and consistent pathological features in mice. Pertussis toxin (PT) in the presence or absence of murine recombinant interleukin-12 (mrIL-12) was used as an adjuvant with bovine peripheral nerve myelin (BPNM) to induce clinical EAN in SJL/J mice. After immunization with a combination of BPNM in complete Freund's adjuvant (CFA) and PT, mice developed severe consistent signs of EAN. The additional treatment of immunized mice with mrIL-12 prolonged the course of EAN characterized by earlier clinical signs of the disease and delayed the recovery stage. Mice injected with BPNM and CFA without PT developed mild clinical signs. Histological examination of the caudae equinae and the sciatic nerves taken from mice with clinical signs of EAN during the recovery stage revealed severe demyelination, remyelination and remnants of mononuclear cell infiltration. Moderate to severe EAN can be induced in SJL/J mice by the injection of a combination of BPNM in CFA and PT. This model can provide a better understanding of mechanism of demyelination in infiltrating peripheral neuropathy.
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Affiliation(s)
- D M Calida
- Department of Neurology, University of Pennsylvania, Medical Center, 3400 Spruce Street, Philadelphia, PA 19104-4283, USA
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Choe W, Albright A, Sulcove J, Jaffer S, Hesselgesser J, Lavi E, Crino P, Kolson DL. Functional expression of the seven-transmembrane HIV-1 co-receptor APJ in neural cells. J Neurovirol 2000; 6 Suppl 1:S61-9. [PMID: 10871767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
APJ is a recently described seven-transmembrane (7TM) receptor that is abundantly expressed in the central nervous system (CNS). This suggests an important role for APJ in neural development and/or function, but neither its cellular distribution nor its function have been defined. APJ can also serve as a co-receptor with CD4 for fusion and infection by some strains of human immunodeficiency virus (HIV-1) in vitro, suggesting a role in HIV neuropathogenesis if it were expressed on CD4-positive CNS cells. To address this, we examined APJ expression in cultured neurons, astrocytes, oligodendrocytes, microglia and monocyte-derived macrophages utilizing both immunocytochemical staining with a polyclonal anti-APJ antibody and RT - PCR. We also analyzed the ability of a recently identified APJ peptide ligand, apelin, to induce calcium elevations in cultured neural cells. APJ was expressed at a high level in neurons and oligodendrocytes, and at lower levels in astrocytes. In contrast, APJ was not expressed in either primary microglia or monocyte-derived macrophages. Several forms of the APJ peptide ligand induced calcium elevations in neurons. Thus, APJ is selectively expressed in certain CNS cell types and mediates intracellular signals in neurons, suggesting that APJ may normally play a role in signaling in the CNS. However, the absence of APJ expression in microglia and macrophages, the prinicpal CD4-positive cell types in the brain, indicates that APJ is unlikely to mediate HIV-1 infection in the CNS.
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Affiliation(s)
- W Choe
- Department of Neurology, University of Pennsylvania, Philadelphia, Pennsylvania, PA 19104, USA
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Perrin PJ, Rumbley CA, Beswick RL, Lavi E, Phillips SM. Differential cytokine and chemokine production characterizes experimental autoimmune meningitis and experimental autoimmune encephalomyelitis. Clin Immunol 2000; 94:114-24. [PMID: 10637096 DOI: 10.1006/clim.1999.4825] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
After primary immunization with myelin/oligodendrocyte glycoprotein, CD28(-/-) mice developed experimental autoimmune meningitis (EAM) rather than experimental autoimmune encephalomyelitis (EAE). Cytokine and chemokine production in EAE and EAM were compared to understand the differences in disease phenotype. T cells from the central nervous system lesions of mice with either EAE or EAM expressed intracellular TNF-alpha. Splenic T cells from mice with EAM produced TNF-alpha and IL-6 but no IL-2. Conversely, EAE-derived splenic T cells produced TNF-alpha and IL-2 but no IL-6. Altered T cell differentiation in EAM was not due to a Th1 to Th2 shift, because equivalent amounts of T cell IFN-gamma mRNA were produced in both diseases. Neutrophils also produced inflammatory mediators such as TNF-alpha and IL-6 in EAM. Autocrine production of MIP-2 mRNA was observed in neutrophils from mice with EAM but not EAE. Therefore, distinct patterns of cytokines and chemokines distinguish EAE and EAM.
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Affiliation(s)
- P J Perrin
- Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA
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49
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Constantinescu CS, Lavi E. Anterior uveitis in murine relapsing experimental autoimmune encephalomyelitis (EAE), a mouse model of multiple sclerosis (MS). Curr Eye Res 2000; 20:71-6. [PMID: 10611718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
Abstract
PURPOSE To investigate whether anterior uveitis (AU), which often accompanies central nervous system (CNS) and systemic inflammatory diseases including multiple sclerosis (MS), also develops in a murine relapsing model of MS, experimental autoimmune encephalomyelitis (EAE) closely resembling relapsing-remitting MS, induced by immunization with myelin basic protein (MBP) in mice. METHODS (PL/J x SJL) F1 female mice were immunized with MBP in complete Freund's adjuvant (CFA) using Pertussis toxin as co-adjuvant. EAE was scored clinically on a scale of 0-5 based on the degree of paralysis. Uveitis was assessed by slit-lamp biomicroscopy. Histolological analysis of the CNS and eye were performed. RESULTS All immunized mice developed a characteristic relapsing paralysis. Evidence of AU was present late in the course of EAE, only after the resolution of the first clinical relapse, in 4 of 5 mice (80%) (clinical evidence) and 5 of 5 (100%) (histological evidence). AU was mild to moderate with the exception of one animal, in which it was severe. Involvement was invariably bilateral. Histology showed mononuclear infiltrates in the iris and ciliary body. Bilateral secondary cataracts were observed in the animal with severe inflammation. Paralytic episodes and the AU did not coincide. There were no clinical or histological eye abnormalities in control mice, either non-immunized or immunized with CFA and Pertussis toxin only. CONCLUSION We report AU in a mouse model of EAE which strongly resembles relapsing MS. These results further suggest shared antigenic determinants between the CNS and the eye, which likely become exposed to the immune system late in the course of CNS inflammation.
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Abstract
The presence of terminally differentiated slow- and non-dividing cells in the central nervous system (CNS) provides a safe harbor for viral persistence and latency and constitutes a unique immunologic environment for viral infections. Studies of experimental model systems of viral infections of the CNS provide insight into mechanisms of viral persistence and immune-mediated pathology. Nidoviruses are comprised of 2 families of viruses, coronaviruses and arteriviruses, and are common pathogens of humans and a variety of animal species. Both families of viruses contain neurotropic strains that produce experimental neurologic diseases in rodents. These include acute meningitis and encephalitis; acute poliomyelitis; and chronic inflammatory, immune-mediated, demyelination. Coronavirus-induced demyelinating disease mimics many of the pathologic features of Multiple Sclerosis (MS).
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Affiliation(s)
- E Lavi
- Department of Pathology and Laboratory Medicine, University of Pennsylvania School of Medicine, Philadelphia 19104-6100, USA
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